Epidemiological assessment of hepatitis B and C among migrants in the EU/EEA

Technical report
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European Centre for Disease Prevention and Control. Epidemiological assessment of hepatitis B and C among migrants in the EU/EEA. Stockholm: ECDC; 2016.

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​This report gives an overview of chronic hepatitis B and C virus infection among foreign-born migrants in the EU/EEA. Effective antiviral treatment is available for hepatitis B and C but the main bottleneck in providing treatment is case detection. ‘Foreign-born migrants’ – those born outside their current country of residence – are one of the key populations at higher risk of getting hepatitis B and C in the EU/EEA and thus important targets for prevention and care programmes. In order to inform policy-making and healthcare planning, it is crucial to have a good understanding of the burden of hepatitis B and C infection among this group. This will enable policymakers to prepare the ground for targeted screening programmes and other prevention measures.

Executive summary

One of the main challenges in the control of hepatitis B and C is identifying those who do not even know they are infected. Only then can they benefit from the appropriate antiviral treatment and the risk of further spread can be reduced. In many countries of the European Union and European Economic Area (EU/EEA), migrants are known to be one of the key populations at higher risk of infection with hepatitis B and C. A new ECDC study shows that hepatitis-specific prevention and care programmes need to target such key groups at risk of infection.

​It is estimated that possibly up to 75% of those infected with the hepatitis virus are not aware of their status as hepatitis is often asymptomatic – however the risk of the infection progressing silently to cirrhosis or liver cancer persists.  Identifying those who are infected and then linking these to timely treatment will decrease the health burden of chronically infected persons and provide opportunities for significant future savings of associated healthcare costs.

How to identify more hepatitis cases: targeted screening of key populations

Targeted screening of risk groups could improve case detection in Europe. Foreign-born migrants – which refers to those born outside their current country of residence – are one of the key populations at higher risk of hepatitis B and C in many EU/EEA countries. In order to inform policy making and healthcare planning, it is crucial to have a better understanding of the burden of hepatitis B and C infection among migrants as this will enable targeted screening programmes and other prevention measures.
 
The aim of this new ECDC study is to estimate the chronic viral hepatitis burden in terms of infected cases among first-generation migrants in EU/EEA countries based on best available data sources.  The study also aims to identify those migrant groups with the largest number of cases who would benefit most from targeted screening programmes and early linkage to care.

The study found that migrants account for an estimated 25% of the chronic hepatitis B (HBV), and 14% of the chronic hepatitis C (HCV) cases in the EU/EEA. This is higher than the proportion of migrants in the total population, which is 5% for migrants from HBV intermediate and high endemicity countries and 8% for migrants from HCV high endemicity countries.
 
In some countries (i.e. Ireland, the Netherlands and Sweden) the contribution of chronic viral hepatitis B cases among migrants coming from intermediate and high-endemicity countries to the overall burden in the host country was estimated to be exceptionally high.
 
The report also notes that despite a high burden of chronic viral hepatitis infections among migrants, the risk of onward transmission of infection is likely to be low.
 
To reduce the overall burden of chronic viral hepatitis in EU/EEA countries, it is therefore important to ensure that hepatitis-specific prevention and care programs target foreign-born migrant populations, providing opportunities for timely treatment and significant savings of further healthcare costs.